gms | German Medical Science

Introduction: Human behavior contains information about people's mood and emotional states that cannot be captured by direct physical biomarkers such as heart rate or blood pressure. Peoples’ digital behavior could serve as a surrogate in this context, as it implies information about the person's emotional or affective states. Using digital footprints to detect changes in mood, cognition and mental states is called “digital phenotyping” [1]. As this approach promises better prevention of mental disorders, a more accurate measurement of mental states and even the prediction of psychiatric relapses, digital phenotyping has the potential to revolutionize modern psychiatry. However, to fulfil this potential, it is of key importance that the stakeholders involved accept it. To date, no systematic literature review exists that explores the perspective from different stakeholders towards digital phenotyping in mental health care. This scoping review aims to close this research gap.

Methods: The scoping review follows the updated JBI guidelines for scoping reviews [2] and builds on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) [3]. The research question was translated into a search string that was peer-reviewed according to the PRESS guideline [4] and adapted for eleven databases. Titles and abstracts of the retrieved articles were screened; peer-reviewed articles, pre-prints and conference proceedings published in English language since 2000 were included in the full-text screening. Additional literature was identified by screening the reference lists of relevant articles. A narrative synthesis approach was used to summarize and catalogue empirical research on the acceptability of digital phenotyping in psychiatry.

Results: Much of the current literature on digital phenotyping in psychiatry neglects to relate empirical research to attitudes and individual decision-making processes. Overall, existing studies show that the acceptability of digital phenotyping in mental health care is highly dependent on the type of data used for digital phenotyping. Concerns about compromising ethical values (such as privacy and data protection) when using digital phenotyping in mental health care are pervasive among all stakeholders surveyed. To date, empirical research on the acceptability of digital phenotyping in mental health care is scarce and representative studies are missing. Most quantitative studies are based on convenience samples of health care professionals or patients from the same local mental health care facilities. Qualitative interviews and focus groups that explore the issue in more depth have interviewed mostly non-patient representatives of the general population.

Conclusion: Knowledge on acceptable type of data and data protection is crucial for an increased use of digital phenotyping. However, there is a strong need for further empirical work on the acceptability of digital phenotyping in mental health care, especially in the European context. Future research should consider multiple stakeholder groups, considering the multidimensionality of acceptability – including technical, normative and communicational aspects - and building on a theoretical concept such as the Theoretical Framework of Acceptability proposed by Sekhon et al. [5]. This scoping review highlights the importance, yet neglect, of studying stakeholder acceptability and involving them in the development and implementation of digital phenotyping technologies in psychiatry.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.